What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary heart disease (n=5389). Intervention: Arterial pulse pressure vs. Lower pulse pressure. Primary outcome: Coronary heart disease risk (HR ~1.10).

September 1, 2005

Importance of arterial pulse pressure as a predictor of coronary heart disease risk in PROCAM

Key Result

Arterial pulse pressure ≥70 mmHg was associated with a more than threefold higher risk of coronary heart disease over 10 years compared to <50 mmHg in European men.

Study Design

Type

Cohort (n=5,389)

Structured PICO

Does increased pulse pressure independently predict coronary heart disease risk in middle-aged and older men?

Population

5,389 European men aged 35-65 at recruitment into PROCAM

Intervention

Increased pulse pressure (PP), systolic blood pressure (SBP), and diastolic blood pressure (DBP)

Comparator

Lower levels of PP, SBP, and DBP (e.g., PP <50 mmHg)

Outcome

Coronary heart disease (CHD) riskhard clinical

Increased pulse pressure is an important independent predictor of coronary heart disease risk in older European men, even among those initially considered normotensive.

Main Result

Effect estimate: HR ~1.10

Abstract

AIMS: To investigate pulse pressure (PP) as an independent predictor of coronary heart disease (CHD) risk. METHODS AND RESULTS: On the basis of a 10-year follow-up of 5389 men aged 35-65 at recruitment into PROCAM, we used a proportional hazards model to calculate the effect of systolic blood pressure (SBP), diastolic blood pressure (DBP), and PP on CHD risk after correcting for age, high-density lipoprotein cholesterol, LDL cholesterol, triglycerides, smoking, diabetes, and family history of premature CHD. Increases of 10 mmHg in DBP, SBP, and PP were associated with an increased CHD hazard ratio (HR) of approximately 10%. When the group was divided into the age groups 59 years, this relationship was seen in the age group 50-59 years for DBP, SBP, and PP and in men aged > or =60 for PP only (25% increase in HR). Overall, CHD risk in men with PP > or =70 mmHg was more three times that of men with PP 60 years, and was also present in men who were normotensive at recruitment (SBP < or =160 mmHg, DBP < or =95 mmHg). CONCLUSION: In older European men, increased PP is an important independent determinant of coronary risk, even among those initially considered normotensive.

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